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A surge in the incidence of invasive Group A Streptococcus hand infections: a single Hand Unit experience.
No full textWe highlight an increase in the number of invasive Group A streptococcal soft tissue infections and present the impact of those on the hand surgery service, based on a single Hand Unit experience at the Pulvertaft Hand Centre
Does earlier investigation of first-time traumatic shoulder dislocation lead to a reduction in the rate of recurrent dislocations?
No full textBACKGROUND: The British Elbow and Shoulder Society (BESS) introduced national guidance for first-time traumatic shoulder instability in 2015. The aim of this case-control study was to evaluate the effect on re-dislocation rate following adoption of their imaging protocol in our department in 2016. METHOD: We included patients >16 years old with first traumatic shoulder dislocations between: January 2013 to December 2013 and January 2016 to September 2016 (pre-guidance) and October 2016 to December 2019 (post-guidance). Clinical records were analysed to determine imaging and surgery rates, respective lag times and re-dislocation rates. Follow-up was set at 4 years. RESULTS: The study comprised 144 pre-guidance and 342 post-guidance patients. MRI arthrograms performed in 40 s increased from 42.6% to 60.1% (p < 0.05), with a significant lag time reduction (p < 0.001). Time to surgery decreased from 432 to 249 days. Overall re-dislocations decreased from 14.6% to 8.5% (p < 0.05), and mean dislocations from 1.33 to 1.14 (p = 0.028). In < 25 s, percentage of ≥3 dislocations decreased from 19.0% to 3.03% (p = 0.005). CONCLUSIONS: BESS guideline implementation has resulted in increased rates of imaging and reduced lag times to imaging and surgery. Re-dislocations rates have significantly decreased
Intranasal oxytocin modulates brain activity during emotional processing in children with treatment resistant conduct problems
Get PDF© The Author(s) 2025 This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.One of the most highly replicated neural correlates of Conduct Problems (CP) is amygdala hypoactivity to another person's fear. We recently reported that this correlate was only observed in boys with persistent CP (i.e. antisocial behaviour that persisted following a gold-standard psychological intervention), suggesting that amygdala hypoactivity to fear could be an important neural signature for treatment-resistant CP, and a putative target for future treatments. Potential treatment candidates include the oxytocin system, as this has been reported to modulate amygdala activity and social behaviour across species. Further, in adults with antisocial personality disorder, intranasal oxytocin improved facial emotion recognition for fearful and happy faces. However, to-date, no-one has studied whether intranasal oxytocin can normalise neural processing differences in children with CP. Twenty boys (mean age 9.85±1.26 years) with persistent CP underwent functional magnetic resonance imaging in a within-subject randomised control design to investigate whether, compared to placebo, a single-dose of intranasal oxytocin could 'shift' abnormal neural processing to fear. Oxytocin failed to reduce amygdala hypoactivity to fearful faces, but increased activation in the posterior cingulate cortex / precuneus to happy faces. These findings tentatively suggest that intranasal oxytocin may promote a more neurotypical profile in treatment-resistant CP children, therefore, supporting the merit of investigating oxytocin in further larger clinical studies in this population.https://www.nature.com/articles/s41598-025-92276-
Transforming healthcare delivery : a comprehensive review of digital integration, challenges, and best practices in integrated care systems
Get PDF© 2025 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Digital transformation in healthcare, particularly within Integrated Care Systems (ICS), offers significant potential to improve the quality, accessibility, and efficiency of care. This narrative review examines the best practices, challenges, and outcomes of digital healthcare transformation within ICS, with a focus on the integration of key technologies such as electronic health records (EHRs), telemedicine, and artificial intelligence (AI). The review highlights the critical role of leadership, stakeholder engagement, and staff training in overcoming barriers to successful digital adoption, including resistance to change, interoperability issues, and financial constraints. It further explores the impact of digital tools on patient outcomes, operational efficiency, and patient engagement. Despite the promise of digital transformation, several challenges persist, including technological barriers, regulatory complexities, and the need for significant investment in infrastructure. To maximize the benefits of digital healthcare tools, the review recommends fostering collaboration among healthcare providers, prioritizing staff involvement and leadership support, implementing digital solutions in phases, and addressing financial and regulatory challenges early in the planning process. By addressing these challenges and implementing recommended strategies, ICS can enhance care coordination, optimize resource utilization, and ultimately improve patient outcomes, paving the way for a more sustainable healthcare system.https://www.sciencedirect.com/science/article/pii/S2950550X2500022
Digital assistive technologies for community-dwelling people with dementia : a systematic review of systematic reviews by the INTERDEM AI & assistive technology taskforce
Get PDF© The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://
creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Introduction The use of digital assistive technologies by and for people living with dementia is promising for supporting social health and advocated as a partial solution to growing prevalence worldwide. A state-of-the-art position paper published in 2017 identified challenges regarding digital assistive technologies, around five themes: development, usability, (cost-)effectiveness, implementation and ethics. This systematic review summarizes progress on the challenges found in 2017, and persisting or emerging challenges.Methods A systematic review of systematic reviews was conducted, focused on studies published after 2016. The inclusion criteria required that the target group included, at least in part, people with dementia living in the community and that the technologies aimed to support social health. For the five themes, literature searches were conducted in Medline, CINAHL, PsycINFO, and Embase databases.Results A total of 112 reviews were included, covering various applications such as smart homes, care robots, exergaming and everyday technologies. No applications of artificial intelligence were included. The challenges included personalization of applications (development); limited use of standardized methods (usability); insufficient quantity and quality of randomized controlled trials (cost-effectiveness); overly high expectations of assistive technologies (implementation); and the need for more equitable access to technologies (ethics).Conclusion Much research has been conducted since the 2017 state of the art position paper. While some challenges identified at that time remain relevant, others have been addressed, and new challenges have emerged. Future research should prioritize emerging artificial intelligence applications; the development of integrated assistive technologies; evaluation using robust methods and meaningful outcomes; and the promotion of more accessible and inclusive technologies.https://journals.sagepub.com/doi/abs/10.1177/2055207625136235
Improving Tic services in England : a multi-method study to explore existing healthcare service provision for children and young people with tics and Tourette syndrome
Get PDF© Author(s) (or their
employer(s)) 2025. Re-use
permitted under CC BY.
Published by BMJ GroupBackground Timely access to diagnostic assessment and treatment is essential to improve function and mitigate the risk of poor long-term outcomes in children and young people (CYP) with tics.Objective This study aimed to explore (i) how tic services for CYP in England are currently organised, including access to assessment and treatment and (ii) healthcare professionals’ (HCPs) experiences of assessing and treating tics.Methods Two methodologies were used to examine tic service provision. First, two freedom of information (FOI) requests were sent to Integrated Care Boards (FOI1) and service providers (FOI2) to gather data on referral and assessment processes, and treatments offered. Second, a national survey of HCPs explored their experiences and training needs when assessing and treating tics.Findings FOI responses indicated that 12 of 62 services (19.4%), primarily located in the London area, offered a full pathway for the referral, assessment and treatment of tics in CYP.The national survey sample (n=184) included psychologists, paediatricians, neurologists and mental health nurses. Most described services as poorly structured and reported a need for additional resources and training in the assessment and treatment of tics.Conclusions Inconsistent and underfunded tic service provision across England limits HCPs’ ability to support CYP with tics effectively. There is an urgent need to develop clear service pathways offering both assessment and treatment, and to equip HCPs with sufficient training and resources to provide appropriate care.Clinical implications Current tic service provision does not meet the healthcare needs of CYP in England. Without improvements, CYP are at increased risk of poorer long-term outcomes.https://mentalhealth.bmj.com/content/28/1/e30159
The Nottingham Guide: How to do a literature review
No full textTrainee Psychiatrists in the Child and Adolescent Mental Health Services (CAMHS) are expected to undertake a systematic review as part of their Specialty Trainee (ST) 4-6 Higher Training. In my role as Senior Knowledge Specialist, I support these trainees by attending a quarterly research workshop, where trainees and mentoring consultants share knowledge and experience and support each other through the process of undertaking a systematic review. The aim is to understand the process, select an appropriate question (preferably CAMHS-based), and go through all the steps of a systematic review. Some go on to publish, but that’s not a requirement. My role is to advise on scoping the topic (has it already been published?), establish the search strategy, either run the search or provide training to the trainees on searching the databases, provide support on referencing, comply with PRISMA, peer-reviewmanuscripts, and find target journals to publish in. In 2016, the consultants decided to write a formal guide to support the trainees undertaking the review process, as well as the trainers to refer to when advising how to undertake a review. The aim was to circulate it amongst anyone who was interested in undertaking a review as part of their training. When the library was asked to join the workshop in 2017, they asked me to review the content of the guide, and between the four of us (three consultants and myself), we created “How to do a literature review: A guide for Specialty Trainees”.It goes through choosing a subject, arranging a meeting with the library, performing a scoping search, registering with PROSPERO, performing a search, title/abstract screening, grouping articles into topics, data extraction, writing the paper, and peer-reviewing and feedback. In July 2025, the Chair of the Child and Adolescent Psychiatry Specialist Advisory Committee from the Royal College of Psychiatrists emailed to say the guide was discussed at the faculty meeting and asked for our permission to upload the guide to the faculty website. It was renamed “The Nottingham Guide” and is now available to read under the section “How to do a literature review”: Guide to research for child and adolescent psychiatryhttps://ciliphlg.com/the-nottingham-guide-how-to-do-a-literature-review
Principles of Industry-Academic Partnerships Informed by Digital Mental Health Collaboration : Mixed Methods Study
Get PDF© Sophie S Hall, Olivia Hastings, Kelly Marie Prentice, Beverley Brown, Jacob Andrews, Sonal Marner, Rebecca Wood cock, Jennifer Martin, Charlotte L Hall. Originally published in JMIR Mental Health (https://mental.jmir.org), 10.09.2025.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecom mons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original
publication on https://mental.jmir.org/, as well as this copyright and license information must be includedBACKGROUND: Cross-sector collaboration is increasingly recognized as essential for addressing complex health challenges, including those in mental health. Industry-academic partnerships play a vital role in advancing research and developing health solutions, yet differing priorities and perspectives can make collaboration complex. OBJECTIVE: This study aimed to identify key principles to support effective industry-academic partnerships, from the perspective of industry partners, and develop this into actionable guidance, which can be applied across sectors. Mental health served as a motivating example due to its urgent public health relevance and the growing role of digital innovation. METHODS: Using a 3-stage, mixed-methods approach, we conducted a web-based survey of UK-based digital mental health companies (N=22) to identify key barriers and facilitators to industry-academic partnerships. This was followed by 2 focus groups (n=5) that explored emerging themes from the survey using thematic analysis. Finally, we conducted a workshop with industry representatives, researchers, clinicians, and PPI members to co-develop the Principles of Industry-Academic Partnerships (PIP) guidance. RESULTS: Survey findings highlighted that industry partners valued academic collaboration for enhancing credibility, facilitating knowledge transfer, and gaining access to PPI networks. However, key barriers included high costs, slow academic timelines, and complex contracting processes. The 4 major themes that emerged from the focus groups were: advantages of collaboration, cultural differences between organizations, collaboration models, and structural barriers within universities. Through informed discussions in the workshop, these themes were explored, leading to the development of 14 actionable strategies. These strategies reflect industry perspectives and formed the PIP guidance, categorized under project initiation, defining the scope and agreements, project execution, and promoting sustainability. CONCLUSIONS: The PIP guidance provides a practical framework to support more effective and mutually beneficial collaborations between industry and academia. Developed through the lens of mental health research, the strategies identified are broadly applicable across disciplines where cross-sector partnerships are essential. Industry partners valued academic collaborations for their credibility and scientific rigor, but highlighted persistent structural and cultural barriers within universities. Addressing these challenges by aligning expectations and timelines, adopting flexible collaboration models, and streamlining operational processes can help foster impactful and sustainable partnerships in mental health and beyond.https://mental.jmir.org/2025/1/e77439/author
Role of preoperative Neutrophil-Lymphocyte ratio in predicting prognosis after liver transplantation for chronic liver failure
No full textIntroduction: The neutrophil-lymphocyte ratio (NLR) is an easily calculable biomarker known to have a predictive value in cardiac disease, malignancy, and renal failure. However, it has not been studied before in chronic liver disease patients undergoing liver transplantation. We aimed to evaluate the role of the pre-transplantation NLR in predicting the prognosis of patients with chronic liver failure undergoing liver transplantation. Method: Data was retrospectively collected from 46 patients with chronic liver disease who underwent liver transplantation. The patients were divided into two groups. Group A had 23 patients who survived after liver transplantation. Group B had 23 patients who did not survive. NLR was calculated by dividing the percentage of neutrophils by the percentage of lymphocytes in peripheral blood. The NLR cut-off value was based on a receiver operating characteristic curve analysis. Postoperative complications were also noted. Results: Preoperative NLR of 3.46 can predict post-transplantation mortality, with the area under the curve (AUC) of 0.86, having a sensitivity of 86.96% and a specificity of 73.91%. NLR emerged as an independent predictor of mortality (hazard ratio (HR) = 4.1, p = 0.028) after adjusting for the Model for End-Stage Liver Disease-Sodium (MELD-Na), creatinine, and neutrophil count. A rising NLR trend was significantly associated with the development of postoperative complications like neurological disease (p < 0.001), coagulopathy (p = 0.004), and acute kidney injury (p = 0.043). Conclusion: A high preoperative NLR is a predictor of poor outcomes in liver transplantation patients with chronic liver disease.https://www.cureus.com/articles/341481-role-of-preoperative-neutrophil-lymphocyte-ratio-in-predicting-prognosis-after-liver-transplantation-for-chronic-liver-failure#!